An evidence synthesis programme commissioned by the UK’s National Institute for Health Research from two academic teams produced a diverse range of outputs and methodological insights in its first three years of operation. The programme was subsequently re-commissioned for two further cycles. Scoping the topic and involving stakeholders were key to its success.
Matthew Johnson, Elliott Johnson, Laura Webber and Kate Pickett
The COVID-19 pandemic has increased interest in Universal Basic Income (UBI) as a means of addressing a range of socio-economic insecurities. While previous trials of cash transfer schemes have often focused on low-level transfers inadequate to satisfy the needs for which the policy was originally developed, emerging pilots are moving toward a position of increasing generosity. Our multidisciplinary project, Examining the Health Case for UBI, has brought together colleagues in behavioural science, public health, epidemiology and economics to establish pathways to health impact outlined in Figure 1 below. Our work suggests the potential for significant health impact and attendant economic benefit via reduced healthcare costs and increased economic activity. The model suggests that elements of impact may only be felt if payment is set at a more generous level. This could create greater return on investment and, ironically, a more cost-effective system.
We have spent much of our academic and professional careers participating in and leading initiatives that are trying to change how organisations, institutions and systems function. The relentless demands of this work mean there is often little opportunity to reflect on the efficacy of our efforts. To address this gap, we conducted more than two years of ethnographic research to learn how community-university-policy partnerships use research and strategic communication to change how youth homelessness is addressed on a pan-Canadian scale. Our intention was to improve our own tactical efforts to ensure our research contributes to the types of changes we want to see (e.g. an end to youth poverty and homelessness).
We learned that networked knowledge exchange is central to ensuring research-to-policy impact.
In this blog post, we suggest three things researchers can do to produce research that addresses persistent social problems.
Especially in times of crisis, the relationship between evidence and policymaking may change dramatically. The current Covid-19 crisis generated manifestations of ‘evidence informed policymaking’ in an unprecedented way, both nationally and locally. It also showed that the need to use internationally organised, reliable data for effective policy interventions has never been more urgent in times of peace. This information needs to be both profound and directly available.
In the processes of shaping evidence informed policymaking, scientists from all kinds of disciplines play a crucial role to substantiate the development of policies. An international, virtual conference taking place 15–18 December 2020 will treat the outcomes of the current crisis as input for the challenge of professionalising the structured interaction between evidence and policymaking. The current learning processes will be analysed in the context of the existing knowledge infrastructure for policymakers. Instruments for creating evidence for policymakers have recently grown with the introduction of Big Data and the development of algorithms. Another widespread trend is the use of innovative evaluation processes in order to enhance the effectiveness of policy instruments and the growth of new standards for experimental policies.
This special issue uses the lens of Creativity and Co-production to explore the meaning of ‘evidence’ and whose meaning counts. It considers what the terms ‘creating’, ‘making’ and ‘production’ mean with regards knowledge creation, sharing and putting into action. It examines the potential role that created artefacts play. For example, what are the values embodied and represented in ‘knowledge artefacts’ and what affordance and agency might they give to human actors?
Areas for discussion include:
What evidence is valid, who produces it, and how was it produced?
What is the process by which ‘evidence’ can be interrogated by others, made sense of, and acted upon?
Not acting on evidence is commonly described as the ‘evidence gap’. Could this be broken down into a series of ‘micro’ gaps between Evidence and Knowledge, Knowledge and Knowing, Knowing and Action?
What role do creative practices, tangible objects, and visual language play in bridging each of these micro gaps?
How do we implement shared decision-making into routine practice? Health systems are struggling with this question worldwide. Instead of simplifying this challenge into barriers and facilitators, what if we embraced its complexity?
In recent years there have been increasing calls for the implementation of shared decision-making in routine clinical care. Shared decision-making is particularly helpful for decisions where there are multiple appropriate options, and the ‘best’ decision rests with the patient’s preferences.
In my work with federal agencies over the last 15 years on violence prevention, social emotional learning, mental health and homelessness, the idea of translating research to practice has become increasingly important. We know there is a gap between what we discover through research and what is applied by practitioners, funders and policymakers.
Over the past decade, federal agencies — and the US Department of Health and Human Services (HHS), in particular — have sought to learn more about the ‘science’ of implementing programmes, practices and policies. They want to invest smartly and do a better job of ensuring the most evidence-based decisions. These are noble goals — especially during this pandemic, when health and human service organizations are being asked to do things they have never done before, with lightning speed. Unfortunately, it gets complicated fast: Each field has its own terminology, frameworks and measures, making it difficult to synthesise information and create a shared body of knowledge across disciplines. So where do we start?
On the understanding that human beings are relational and storytelling animals, who make sense of the world through narrative and dialogue, we developed a story-telling approach to using evidence, which started by developing what has been described as an ‘enriched environment of care and learning’. Within such an environment, everyone involved should gain a sense of security, continuity, belonging, purpose, achievement and significance. To enable this, we started with their priorities and valued their evidence (i.e. practice knowledge, lived experience of older people and carers and organisational knowledge), alongside the research evidence, which we were careful not to impose on them. A challenge for the research team was how to do this.
What does it mean to use evidence in policymaking? This seemingly simple question has been remarkably under-defined in all the calls for increased use of evidence. Indeed, many of those who champion ‘evidence-based policymaking’ do little to explain what it means for a policy to be evidence-based, and have trouble explaining what evidence use actually means when decision makers have multiple competing goals and social concerns. Evidence is simply seen as a good thing – and more use is better – without really considering what that means or what happens when there is disagreement around which evidence to use for what goals.
Policy scholars who study evidence, on the other hand, have approached the issue from the perspective that ‘evidence use’ can mean any number of things within a policy setting. The literature can, therefore, appear divided into two extremes: either evidence use is taken for granted to be a known (assumed to be good) thing, with little consideration of political realities, or alternatively it is seen as multidimensional, the form of which is constructed by the nature of policy ideas, processes, and interactions.
Our university-policy maker partnership produces ‘fake’ abstracts of articles we’ve not written yet (on results we frankly don’t even know we’ve got) to loosen up thinking. It helps the team visualise pathways for policy action.
Ours is a tricky situation, politically-speaking. A health department is undertaking Australia’s largest ever scale-up of evidence-based childhood obesity programs into every school and childcare centre across the state. It costs $45m. They have an electronic data monitoring system in place. It’s already telling them that targets are being met. But rather than just rest on their success, they invite a team of researchers to do a behind-the-scenes, no-holds-barred ethnography. It could reveal the ‘real’ story of what’s goes on at the ground level.